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Sciatica - herniated disk? -Help/Advice pleeze!

post #1 of 29
Thread Starter 
Background (long, sorry!)
Racing at Mammoth last weekend I took a big dinger in the slalom on Friday. Didn't notice any pain or anything. On saturday I did a GS and by Saturday night my back was feeling a little stiff. Nothing unusual for an oldie like me so some ibuprofen as the usual cure. On sunday, another GS, pain still there and by my second run getting worse so packed up after the race and downed some more Ib. A fairly uncomfortable drive home but WTF, I had got some decent results and raced well (for me) . Pain was in the lower right lumber regionand gradually eased off during the week (usually felt it worst when i got up out of my desk chair).

By friday it seemed to have subsided so i thought it should be OK and headed up to Big Sky for the masters nationals. Warming up yesterday everything seemed OK and no issues. However by the time i was halfway down the DH training run I could feel the twinges again. So, thought I would just take it easy, do another couple of inspection runs and then anaethitize it with beer. Of course sods law takes over and i take a really stupid fall on my side when i sideslipped against my pole (dumba** gaper move). Winded me a bit and of course it was on the same side that was hurting but no biggie I thought. So, I packed up for the day. Walking back to the truck I could feel uncomfortable pain all the way down my right leg. Drove back to the hotel and could hardly support myself on my right leg. Walk 30 feet, try to recover from the pain and then drag myself another 30 feet. Tried icing it/hot soaks etc. but pain getting pretty bad leaving me rolling on the floor and Ib not offering any relief. So, off to Bozeman ER where they xrayed etc and diagnosed problem as coming from the sciatic nerve, could be just brusiing but if pain doesn't go away I might want to get checked out for herniated disk. Prescribed tylox plus gave me a muscle relaxant shot and told to rest (So i guess i shouldn't race DH tomorrow doc?: )

Well, today pain just as bad, not able to walk more than 10 feet without bringing tears to my eyes so even i have to accept that i sure ain't going to be skiing this week, far less racing. Actually least pain is when i am sitting down.

Did some web searches to see what herniated disk/sciatica etc involves and it sounds pretty consistent with the symptoms. (ok I guess i should believe the doc)

So (finally!) help/advice please from anyone out there with experience of similar issues. Is this likely to clear up with rest? How long? Should I go for an MRI to check out the disk? I sure ain't used to pain like this and ain't greatly looking forward to the drive back. was advised not to drive with the meds so will switch to celebrex or Ibuprofen till i get home.
post #2 of 29
I dont know ow old you are but most of us are walking around with herniated discs. The more likely cause is muscular. Particularly spasms of the muscles. In the future ice for 48hours, no heat

http://sportspainusa.com/
post #3 of 29
I've heard hundreds of hours of expert testimony on herniated disks. If you're pain is in your back, it is most likely muscular, and not a herniated disk unless you also have leg pain. A herniated disk puts pressure on the nerve root coming out of your spine. You feel the pain and numbness in your leg, not pain in you back. Now you can injure your back and herniate a disk and you might feel pain in both areas. However, to repeat, pain in your back does not mean you have a herniated disk. Herniated disc can be diagnosed with various leg raises in your physician's office and confirmed by an MRI, not an x-ray. The area of leg pain tells the physician what spinal level has the injury. Most herniated disk can be cleared up with steroids and physical therapy.
post #4 of 29
Thread Starter 
Quote:
Originally Posted by MJB View Post
I've heard hundreds of hours of expert testimony on herniated disks. If you're pain is in your back, it is most likely muscular, and not a herniated disk unless you also have leg pain. A herniated disk puts pressure on the nerve root coming out of your spine. You feel the pain and numbness in your leg, not pain in you back. Now you can injure your back and herniate a disk and you might feel pain in both areas. However, to repeat, pain in your back does not mean you have a herniated disk. Herniated disc can be diagnosed with various leg raises in your physician's office and confirmed by an MRI, not an x-ray. The area of leg pain tells the physician what spinal level has the injury. Most herniated disk can be cleared up with steroids and physical therapy.
thanks MJB. I profess to knowing nothing about the condition except for how much pain it is causing me at the moment. Crawling about the room on hands and knees as it is less painful than trying to walk.

Yes pain is all the way down right leg since yesterday. Xray was to check out pelvis and the ER doc advised that MRI would be required to check out disc.

Oh and age 52, so old body has taken a fair bit of abuse over the years but fortunately relatively injury free
post #5 of 29
I'm 26 and have had for about 7 years what I have been told by Drs (though never an MRI) is probably a herniated disc. It began with a volleyball incident; I came down from a block too hard in a really funny way. It's pretty much like what you describe: sharp pain in the lower back (one particular side I think) that radiates down my leg. It's gotten much better over the years (with stretching and core strength) to the point that I hardly feel it anymore, although for at least a few years it was noticeable at many times throughout every day (some worse than others).

I remember when I first did it the pain was excruciating. I couldn't really walk or sit.

The only problem I have now is that every once in a while (once every two years approximately, although the frequency seems to be decreasing) I irritate it playing basketball or volleyball and experience almost the same pain/dehabilitation I did when I first injured it. My solution (besides lots of stretching and core work) has been to recognize when it's getting irritated and immediately cease physical activity for at least a day or two. It almost always starts rather small, but very quickly I found that physical activity would exacerbate it REALLY quickly.

Anyway, I'm obviously no doctor and have no real insite into your problem. Just thought I'd offer my experience with something that sounds similar.
post #6 of 29

this is really a good place to ask for a differential diagnosis

since no one agrees on much here, how would you know which answer was correct, if any?
post #7 of 29
Get an MRI I say! I just went through the worst experience of my life with my back. Thought I strained something in my low back helping friends move. Was just kinda nagging me for a few days then one evening the world was knocked completely out from under me! Could not sit, stand, or lie in ANY position without exterme, excruciating (what I later started calling teeth clinching - tear squirting pain). Took STRONG pain pills - no help. Went to MD and was told it looked like a disk injury, was prescribed more pain meds and sent to PT and they gave me ice, ultra sound, and electric stimulation that temporarily helped a little. Went to my trusted - not your run - of - the - mill chiropracter and he thought it didn't look that "disky" he put it. He suggested I might have torn a little muscle in my butt called the piriformis and told me these things just take a number of weeks to heal. At a later PT visit I saw the "big shot" therapist (former ski team therapist - yadda, yadda, yadda, - lots of letters after his name and all that) who twisted my leg, made me cry and proclaimed "you've torn your piriformis - thats you're problem".
Well their protocol of course was excersize. I've been through other rehabs before and I can appreciate this approach - just that in this case it only aggrevated things! It got to a point where I practically BEGGED them - "can I please just have the ultrasound only" By this time I had seen my chiropractor, my MD, my new PT, 2 different massage therapists and an acupuncturist. I was gettting so desperate I would have gone to a witch doctor if I could've found one. Of course every one I saw was confident their particular discipline would "fix" me. Finally the PT saw I was'nt improving and told me to go get an MRI.
By this time I had done a lot of research and was finding out that MOST back problems "resolve themselves" within 6-10 weeks NO MATTER WHO TREATS YOU! Now being without insurance and facing a $2000 MRI on top of all the other expenses and loss of income I decided to ride it out a little longer.
Well things did not get better - in fact they got worse! Pain meds where not helping (except the brief period the MD had me on prednezone - which I abandoned after my chiro. had a FIT) and I had virtually totally lost my appetite. I lost about 30 lbs. in 6 weeks! Looking back now I think I was begining to "circle the drain". So finally I found some assistance with the cost and got myself in for an MRI. Their radiologist was right there reading the images as they where being made because the tech called him down after what she saw.... they finally pulled me out of the tube and told me I had an infection in my spine and to go DIRECTLY to the emergency room as they where getting a bed and an IV ready for me! AN INFECTION? I argued that I had INJURED my back and NOBODY I had seen even mentioned that possiblity! Besides I had no signs of infection!
At the hospital I learned about what they call SPONTANEOUS INFECTIOUS DISCITUS! Sometimes it "just happens" they told me, as I don't use needle drugs, haven't had any recent surgury or cut myself to the bone with a dirty knife. THIS CAN BE A VERY SERIOUS THING - IT CAN ACTUALLY ERODE YOUR SPINE! I am very lucky - apperantly I got lesser bacteria - not staph and it was mostly in the disk and not the vertebrea. So I didn't have to get liquid antibiotics in my arm - just pills for 4 MONTHS! This all happened 14 months ago and I am mostly better now and skiing but I am told that due to scar tissue I will probably never be quite the same. I have heard horror stories where the infection could'nt be controlled and they have to go in and CUT IT OUT and put in metal to replace the spine as best they can so you at least be basically ambulatory!


SO GET AN MRI - I SAY and best of luck to you - back problems can be real buggers!
post #8 of 29
Thread Starter 
Quote:
Originally Posted by duke walker View Post
since no one agrees on much here, how would you know which answer was correct, if any?
Not looking for a "correct" answer or alternative diagnosis Duke. Just trying to get some feedback from anyone who has had similar issues to get an idea what to expect if it does persist.
post #9 of 29
Quote:
Originally Posted by ScotsSkier View Post
thanks MJB. I profess to knowing nothing about the condition except for how much pain it is causing me at the moment. Crawling about the room on hands and knees as it is less painful than trying to walk.

Yes pain is all the way down right leg since yesterday. Xray was to check out pelvis and the ER doc advised that MRI would be required to check out disc.

Oh and age 52, so old body has taken a fair bit of abuse over the years but fortunately relatively injury free
With pain radiating down your right leg, I suggest that you get a referral to an orthopaedic spine specialist as soon as you can. Sounds like the femoral nerve with the injury at L3/L4 and L4/L5. Leg bends and an MRI will confirm. If so, they'll first give you oral steroids and then a shot in the back called an epidural steroid injection and send you to PT.
post #10 of 29
I second ot thrid the MRI and right away. I had a ruptured disk with an extrusion (basically, the "gel" in the disk was oozing out). There is a newer proceedure that, if you are the right candidate is overwhelmingly sucessful. I can send you a link if yo are interested in learining more. I had the surgery 2.5 years ago and I am 98% cured. I had surgery in August; I was home the same day and was running trails (lightly) in two weeks following surgery. I skied that season. If the disk doesn't shift off the nerve, this is a great alternative. Keep in mind that 80% of all back injuries of this nature will heal regardless of the treatment. So be positive. and I understand the pain you are in. Taking a crap really sucks don't it
post #11 of 29
aaaarrgghh... back pain.

It's definitely not my field of expertise. Nor is it for any other chiropractor. (we have lousy, superficial training in differential diagnosis, and have very limited tools to treat back pain.)

But, at least I can contribute some appropriate information on this thread that should be helpful.

Warning: this post is a little long!


Sciatic symptoms are a little difficult to diagnose, and in many cases are mis-diagnosed. Most of the time, sciatica is dismissively written off as a "disk problem," when that's not the source of pain at all. As volklskier1 points out, many adults have disk bulges and herniations that cause no pain or symptoms whatsoever. (They certainly contribute to weakness and instability at their particular spinal level, however, and that imbalance will tend to further weaken over time if ignored.)

Sciatic symptoms can occur from piriformis problems (the sciatic nerve runs right through the belly of the piriformis), sacroiliac joint problems, a local infection, spinal stenosis (a closing or narrowing of the holes and channels of the spinal bones), space occupying lesions like tumors or cysts, and a host of other things.


Back pain that is localized only to the back region (lumbar, sacral area) is usually (not always) coming from muscular tissue, either from injury or chronic contracture. The following thread link has more information on this:

http://forums.epicski.com/showthread.php?t=44768


But even though the pain is coming from the muscles, the muscles may not be the root cause of the problem. Disk herniations that compress or irritate nerve roots or the cord itself may cause "guarding" of the immediate muscles around the spinal level.

In that case, muscle relaxers, ibuprofen, and other painkillers are simply delaying and prolonging (and sometimes worsening) the problem by tricking your nervous system to stop receiving and interpreting the pain information being sent from the receptors in the damaged tissue.

"Treating pain" as if the pain symptoms are the problem can have dangerous consequences.


And staying on that line of thought... current research does shows that back and neck pain will tend to "resolve on its own," if given enough time. But you know what that means? It means the symptoms improve or disappear. That's the only measurement these crude studies use.

And once you understand that sicknesses, diseases, injuries, and pathology can exist and fester for long periods of time without symptoms... just look at heart disease, diabetes, cancer, etc... then you come to a realization that symptoms are a very inaccurate gauge of your health.

"How you feel" and "how you function" may be two very different things.

In my experience, those folks who ignore their back pain with the hopes that it will "resolve itself" almost always feel better after a few weeks, and their symptoms do subside... but their back pain ALWAYS returns in the near future, oftentimes worse than before.


Moreover, the pain may return because the problem wasn't subluxation or musculoskeletal imbalance. I know of one person who was treated by a chiropractor for over a year, with very marginal improvement, and the idiot chiropractor kept telling her nonsense like "The body heals itself! Healing takes time! You're doing great!" and worst of all... "Don't go to a medical doctor! They'll only prescribe drugs!"

Long story short: She had a tumor on her spinal cord, and by the time she had it surgically removed, the surgery left her paralyzed from the waist down. Guess who got sued successfully for millions of dollars?

I'll give you a hint: it wasn't the surgeon.


Regarding diagnosis: the ONLY way a disk herniation can be diagnosed competently and accurately is with an MRI. You cannot see a disk herniation on plain film X-ray, you cannot confirm a herniation with orthopedic tests like straight leg raisers, or postural analysis, or palpation, or any other manual procedures. One ER doc in a local hospital here told one of my acquaintances that he could feel a couple of "slipped disks" in her spine just by pressing around in the lower back area. :






If you look at this lumbar vertebra viewed from above, the bottom of the picture represents the back of the spine, and the top represents the front of the spine. The back part of the spinal bones have bony attachements for muscle tendons and ligaments. The one sticking straight down is the spinous process that you feel in your back as a little bump.

In order to "feel" a disk herniation, you would have to palpate through 5 layers of muscles overlying the bony processes, through the transverse (side) processes and articular pillars, through the posterior ligamentous linings of the spinal canal, and through the spinal nerve roots.





And as I pointed out above, even if you find a clear herniation on an MRI, that still does not determine the cause of pain! Many people have had failed back surgeries for disk herniations, only to have the same pain (or worse) after surgery, because the cause of pain was something else.


Regarding surgery: In my opinion, surgery should be your last option after you have exhausted everything else. It's risky, and it's a drastic measure to use on spinal problems. Yes, surgery has helped many people with disk problems and back pain. But understand that in virtually all cases of back and spine surgery... your pain may improve or disappear completely, but you have just weakened that area of your spine permanently, whether it be a fusion, cages, laminectomy, discectomy, even excising some of the protruding material. Once you do that, your spine will never be fully functional again, and the rest of your spine has to take extra strain and stress in an attempt to compensate for the altered mechanics.


I wish I could offer more, but I don't have any specific advice to give you, ScotsSkier, especially going off of information on an internet message forum. A good chiropractor may or may not be able to help your "back pain" at this point, depending on what the causative and contributory factors are. Ditto with a good PT. It's likely, but certainly not guaranteed, that you could have avoided this by seeing a chiropractor regularly for proper spinal adjustments (not wham-bam cracking sessions). Even though chiropractic is a lousy, inefficient therapy for back and neck pain, chiropractic used properly can prevent many back problems by keeping the spine free, balanced, and your nervous system transmitting clear information between your brain and all other body structures.


Back, neck, and spinal health is not a matter to be taken lightly, especially if you do any athletics at all. Unfortunately for some folks, it only becomes a serious priority after the damage has been done, and they consequently spend the rest of their lives at the mercy of, and catering to, their neuromusculoskeletal problem.


Skiers, inform yourself and teach yourself about proper fitness, proper nutrition, and proper measures to keep your body strong and functional.... before it's too late.

(sorry so long)
post #12 of 29
^^^^AWESOME INFO HERE^^^^
Every word resonated with what I went through/learned with my bad back experience!
post #13 of 29
Husband suffered with sciatica for years. He had steroid injections which postponed surgery for a couple of years, but eventually had a laminectomy. he is now pain free and skiing bumps. However, Sciatica can have many many causes, not all are disk related.

Chances are yours is temporary. Heat and rest. it takes a looooong time to heal whatever has inflamed that nerve so be patient! anti-inflammatory meds help too. they are as important for their anti inflammatory qualities as they are for pain relief.

Avoid surgery. If you end up there, look into orthoscopic or minimally invasive surgery. My husband would have done that if there was anyone locally who had expertise in it. The recovery time from standard surgery was a real b!tch.
post #14 of 29
Quote:
Originally Posted by Mom View Post
Chances are yours is temporary. Heat and rest. it takes a looooong time to heal whatever has inflamed that nerve so be patient! anti-inflammatory meds help too. they are as important for their anti inflammatory qualities as they are for pain relief.
I have to disagree with you here, Mom.

Chances are that ScotsSkier's sciatic problem is not "temporary." It's likely the end-stage of a long-standing neuromusculoskeletal dysfunction. Aches and pains may come and go during a disease or chronic injury process, but that doesn't make the problem itself "temporary."


And if there is, in fact, inflammation in the area, and is contributing to the problem (particularly if it's chronic inflammation) then heat is the worst thing for it.

Never apply heat to an inflamed area. It will only increase the inflammation and cause more tissue damage.


Anti-inflammatory medication is a temporary cover-up just like painkillers. Again, the problem is not the inflammation itself! Inflammation is a normal physiological reaction by the body's healing mechanisms. It's a necessary step in the healing process, and without it, wounds would never heal and infections would go unchecked.

During initial inflammation, the body's immune system commences a healing cascade by increasing circulation to the damaged connective tissue, stimulating cells called "fibroblasts" to create collagen to increase strength of tendons and ligaments, and stimulates certain hormones and enzymes to commence new cellular growth. When you artificially reduce the initial inflammation process, the result is inadequate blood vessel formation (angiogenesis) and altered/deficient structure of the collagen fibers.


If the inflammation is chronic, to the point that the body cannot "complete" or break the normal cycle of inflammation, then anti-inflammatory medications just prolong the problem. They may temporarily decrease the inflammation, but do not address the underlying problem.


Anti-inflammatory medications serve virtually no beneficial purpose at all to proper healing, in any circumstance. They do not "help" anything, other than pharmaceutical company profits. The only possible outcome by using anti-inflammatory medications is delayed and prolonged tissue weakness, on top of damaging side effects.


**Again, it's very important to understand that pain and inflammation are not the enemy! Pain is a very necessary mechanism whereby the body can inform itself and protect itself from further damage. In fact, it's been shown through medical research that humans who are born without the ability to "feel" pain have a very short life expectancy.

Inflammation is a productive and efficient kick-start to the entire normal physiological process of tissue repair. Chronic inflammation and its associated symptomatology is a warning signal that something is not healing properly... but simply bringing down the inflammation by artificial means does not help, and only allows the underlying problem to get worse!
post #15 of 29
The four main causes of sciatica all have one thing in common. The pain. Beyond that the treatment for each is considerably different. Unfortunately, it sometimes becomes a matter of trial and error as you discover the right cure for your condition. A site that might help you understand sciatica is losethebackpain.com. They also offer diagnostic services but IMO the most important thing to remember is nobody can cure you over the net, get in and have a qualified MD, neurosurgeon, and an orthopaedic specialist give you their opinions.
post #16 of 29
Thread Starter 

great information

Great information guys, very much appreciated. Baja, no worries about the post being too long, the more I can educate myself the better. As an engineer by profession originally I still tend to analyse all the info on a problem to try to get to teh logical approach.

Latest info. On monday, the pain was still pretty bad so I took the meds and laid low, the major problem is that I could hardly walk and can not put any real weight on my right leg. Monday night the pain was excruciating in my knee which i hadn't really noticed on Sunday. No apparent swelling in it tho. Fortunately sitting upright is the least painful position so i managed to drive back home yesterday without too much pain, using ice packs as a back up since i had been warned to stay off teh meds when driving. in bed last night the pain was still bad in my knee and had me worrying that I had done someting to it so this morning back to the local ER for an xray of the knee. Again nothing untoward found, advised just to rest it but given a referral for the orthopedic doc to investigate further so will need to fix an appointment. Hopping about on crutches is teh only way to get about at the moment as trying to walk more tha a few paces leaves me doubled up and shattered.

Wierdest bit of all is that there is no single incident that i can point to and say that could have caused it/aggravated it which worries me (like i said i like to be able to analyse and pinpoint the issue). Usually when i beat myself up I know what has done it. This would be consistent with the deterioration suggested by Baja.

In the interim, just trying to rest it and hope it starts to calm down quickly. All the input and advice here is excellent!! thanks All
post #17 of 29
A crutch was my best friend for a couple of months.Got to where I could push my sweatpants and even my socks off with it (couldn't break forward at the waist at all) Found I could hoist myself out of a chair or off the "toidy" by placing the foot of the crutch between and a little behind my feet, grabbing the armpit saddle with my hands and doing a pull up of sorts. Also baggy sweatpants with big pockets and a pullover with a "kangaroo" pocket were invaluable for totin' things around when walking (or crawling) is something you don't want to do unless you absolutely have to.
Sometimes I would repeat the old Marine mantra to myself.... ''Pain is weakness leaving my body" Oh - and "my tear ducts probably needed to be flushed out anyway"........

Hang in there!
post #18 of 29
Quote:
Originally Posted by ScotsSkier View Post
Great information guys, very much appreciated. Baja, no worries about the post being too long, the more I can educate myself the better. As an engineer by profession originally I still tend to analyse all the info on a problem to try to get to teh logical approach.

Latest info. On monday, the pain was still pretty bad so I took the meds and laid low, the major problem is that I could hardly walk and can not put any real weight on my right leg. Monday night the pain was excruciating in my knee which i hadn't really noticed on Sunday. No apparent swelling in it tho. Fortunately sitting upright is the least painful position so i managed to drive back home yesterday without too much pain, using ice packs as a back up since i had been warned to stay off teh meds when driving. in bed last night the pain was still bad in my knee and had me worrying that I had done someting to it so this morning back to the local ER for an xray of the knee. Again nothing untoward found, advised just to rest it but given a referral for the orthopedic doc to investigate further so will need to fix an appointment. Hopping about on crutches is teh only way to get about at the moment as trying to walk more tha a few paces leaves me doubled up and shattered.

Wierdest bit of all is that there is no single incident that i can point to and say that could have caused it/aggravated it which worries me (like i said i like to be able to analyse and pinpoint the issue). Usually when i beat myself up I know what has done it. This would be consistent with the deterioration suggested by Baja.

In the interim, just trying to rest it and hope it starts to calm down quickly. All the input and advice here is excellent!! thanks All
At age 52, you are no doubt suffering from degenerative disk disease like everybody else who is age 52. A person can't always point to a single injury that caused the problem. Pain in your knee is a sign of nerve root irritation in the spine, especially since you don't have a knee injury.
post #19 of 29
Baja, your points are well taken and it's true you can't get medical advice from the internet. But please don't lead this poor fellow to believe that all sciatica is permanent and that he's staring down the barrel of inevitable surgery. My mother, neighbor and husband all suffered from sciatica and only the latter needed surgery. The others' went away with rest, nsaids, PT and heat. (And i'm talking more than twenty years here, not exactly coming and going.) Heat was the only thing that would relieve the pain. I beg to differ about pain not being the enemy. I give you that pain is an important signal and that relieving pain through medication doesn't 'solve the underlying problem,' but anyone who's had chronic pain can tell you that it is thoroughly debilitating and needs to be controlled. Also, the recommended treatment for sciatica, even when caused by MRI identified disc degeneration is rest and conservative treatment first. it takes time.

from the American Academy of Orthopaedic Surgeons website:

"The condition usually heals itself if you give it enough time and rest. Tell your doctor how your pain started, where it travels and exactly what it feels like. A physical exam may help pinpoint the irritated nerve root. ... Most cases of sciatica affect the L5 or S1 nerve roots. Later, X-rays and other specialized imaging tools such as MRI (magnetic resonance imaging) may confirm your doctor's diagnosis of which nerve roots are affected.
Treatment is aimed at helping you manage your pain without long-term use of medications. First, you'll probably need at least a few days of bed rest while the inflammation goes away. Nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen, aspirin or muscle relaxants may also help. You may find it soothing to put gentle heat or cold on your painful muscles."

underlines added
post #20 of 29
Quote:
Originally Posted by Mom View Post
Baja, your points are well taken and it's true you can't get medical advice from the internet. But please don't lead this poor fellow to believe that all sciatica is permanent and that he's staring down the barrel of inevitable surgery.
With all due respect, Mom, I suggested no such thing. That whole sentence was putting melodramatic words in my mouth, and shows that you did not read the information in my posts.

The fact of this matter is... neither you nor I know enough about ScotsSkier's condition to give any specific advice on what he should do.

"Heat and rest" may be bad advice.

Anti-inflammatory medication may be bad advice.

Telling them to "be patient" may be bad advice.

I was merely offering some general advice to help readers understand what's involved with diagnosing sciatic symptoms, and how many different causes are possible.


But giving any kind of palliative, therapeutic advice to a specific person on an internet message forum is irresponsible... especially when the condition is something as potentially complicated as back pain.


Quote:
I beg to differ about pain not being the enemy. I give you that pain is an important signal and that relieving pain through medication doesn't 'solve the underlying problem,' but anyone who's had chronic pain can tell you that it is thoroughly debilitating and needs to be controlled.
I never denied that pain can be debilitating and profoundly uncomfortable.

Sometimes, healthy adaptive physiology is pretty harsh stuff. (fevers, coughing, swelling, nausea, etc.)

But you cannot say in one breath that "pain is an important signal," then turn around and say "it needs to be controlled (i.e., manipulated by artificial means against the body's own physiology)." Those are contradictory value judgements.


Let's agree to disagree about "pain being the enemy."
post #21 of 29
Thread Starter 

Don't fight over it - It hurts to laugh!

All good feedback - from both perspectives. I really appreciate all the pointers, information resources and POVs being expressed here.

While not trying to diagnose myself through the internet, all the info provided helps satisfy my anal ytical approach and also gets me to a position where I can have a proper dialogue with the specialist when i see him.

I know the advice to give it time to heal is sound but patience unfortunately is not one of my virtues and getting back into the race course too soon after the initial warning certainly aggravated the condition.
I have been pretty fortunate to date in suffering very few skiing injuries apart from the normal sprains, ligaments, cartilage etc. so am not handling the pain/lack of mobility too well. Biggest problem is everytime the pain subsides I start to push myself a bit more and of course it soon reverts back to excruciating: . I guess i should learn from that
post #22 of 29
Quote:
Originally Posted by MJB View Post
I've heard hundreds of hours of expert testimony on herniated disks. If you're pain is in your back, it is most likely muscular, and not a herniated disk unless you also have leg pain. A herniated disk puts pressure on the nerve root coming out of your spine. You feel the pain and numbness in your leg, not pain in you back. Now you can injure your back and herniate a disk and you might feel pain in both areas. However, to repeat, pain in your back does not mean you have a herniated disk. Herniated disc can be diagnosed with various leg raises in your physician's office and confirmed by an MRI, not an x-ray. The area of leg pain tells the physician what spinal level has the injury. Most herniated disk can be cleared up with steroids and physical therapy.
That may be true but it is not always the case. I have a herniated disk and I do not have any leg numbness or pains. I do have chronic back pains. When I get up in the morning I am stiff (my back dirty minds: ) and every so often I am in pain to the point that I am walking around hunched over for a week or so. I have to be conscious at all times about the way I sit bend over and move about, all it takes is one wrong move and I know when I pinched the nerve and the stiffness and pain will ensue. The trick to treating this long term is to strengthen your back, the more muscle you have back there the better support and alignment you will have and the less likely you will be to aggrevate the situation. If you have pain at all times, then you may need surgical intervention.
post #23 of 29
Quote:
Originally Posted by ScotsSkier View Post
Pain lower right lumber region gradually eased off during the week (usually felt it worst when I got up out of my desk chair).

Pain subsided over the week.

I fell skiing again and while walking back to the truck I could feel pain all the way down my right leg. I could hardly support myself with my right leg.

Tried icing/hot soaks etc. but pain getting pretty bad leaving me rolling on the floor and Ib not offering any relief. Bozeman ER x rayed and diagnosed a sciatic nerve bruising/herniated disk. Prescribed tylox, a muscle relaxant shot, and rest.

Well, today pain just as bad, not able to walk more than 10 feet without bringing tears to my eyes

Is this likely to clear up with rest? How long? Should I go for an MRI to check out the disk? I sure ain't used to pain like this and ain't greatly looking forward to the drive back. was advised not to drive with the meds so will switch to celebrex or Ibuprofen till I get home.
I redrafted this to include just the salient material I hope you don’t mind.

I spent 15 years litigating medical claims with a focus on workers’ compensation claims. I have handled thousands of medical cases of which low back issues were predominant.

The docs at Bozeman recommended rest on March 12 it is now March 16, I would give the condition about a week (till March 19th) before pursuing further medical evaluation unless you have a significant change in symptoms for the worse. You may wish to extend this time if you think the use of heat aggravated the healing process.

The good news, many people with injuries like yours do recover and recover fully. The bad news is many do not.

The “how long” question is unanswerable without complete medical workup and unlikely even then. Everyone heals differently and at different speeds. But medical workup will likely be able to tell you what is wrong.

I would hold off on the MRI until 1. You finish the Bozeman ER’s course of conservative therapy. I would be surprised if they did not prescribe rest, ice, and NSAID’s. Is that true or did they not Rx the ice? 2. You see a specialist and are diagnosed and the specialist decides you could use an MRI and (s)he can support the reason for the MRI (you don’t want some charging up your bill to protect his can).

Your injury could be one of a number of variants. It could be just a muscle spasm that is tight enough and located just so that it is affecting the nerve. Presumably the Bozeman ER would have reported this to you. It could be a traumatically induced inflammation of tissue without disc herniation. It could be a frank but intact disc herniation. It could be a frank disc herniation with free fragment. (Either of the last two could need surgical discectomy to remove a portion of the disc) It could be degenerative disc disease, which has compressed the disc leading to nerve root compression that could need laminectomy or other surgical intervention. Or it could be something else. You won’t be able to get the answers to those questions here. Only a good Orthopedist or Neurosurgeon will be able to answer those questions.

As has been discussed above the heat you used on the low back may have caused some exacerbation of the preexisting inflammation. This could delay your natural healing process by some period of time so you might take a bit longer than expected. This really only applies if the condition is fairly minimal traumatically cause compression or the like.

As for NSAID’s I would use the least expensive one that works for you Ibuprophen or Naproxen generics are good alternatives. New to the market NSAID’s do not offer greater benefits than the older drugs in pain relief or anti-inflammation.

Good luck.

Mark
post #24 of 29

Great information...

XJguy and Maddog!

post #25 of 29
Thread Starter 
Thanks maddog. More good advice!.

I have been basically following teh ER advice, icing and taking the Tylox (Oxycodone) as required to deal with the pain. (Didn't overdo the heat, just one hot soak on teh day of teh injury to see if that helped) Seeing the Orthoped specialist on Monday to see what his verdict is.

From my self-analysis (always dangerous!) you may (hopefully!) be on teh right track with the severe muscle spasm. Thigh is a bit numb and pain is worst in knee. Just picked up the X-rays of the knee and they show/state everything normal there. Here's hoping...
post #26 of 29
Thread Starter 

Update from Specialist

Saw the Ortho specialist today and they ran another series of x-rays and checked me out. Base of the spine appears to have a bit of curvature (looked scary bent to me!) and some deterioration as would be expected but nothing too untoward. Doc reckons it is just soft tissue/nerve related and prescribed anti-inflammatories plus physical therapy with an estimate of 2-6 weeks for repair and if this doesn't do it then do further investigation. he reckons the spine curvature is due to the nerve pulling.

This aligns pretty much with what I had arrived at myself from the symptons and a lot of the advice given here. My thigh muscles appear to be almost locked tight as if they are in spasm which is consistent with the nerve getting knocked about (to use a non-technical term!). I had a massage on it on Saturday which helped slightly but a lot more work will be required.

they can't see me for PT before next week so I'm going to try cycling a bit tomorrow to see if it helps any.

Hoewever on the plus side I have managed to lose 6-7 pounds over the last week!
post #27 of 29

Interesting News on the Surgical Front

Relief for neck discs, but docs say it will be a challenge to replace lumbar dics too.

http://news.bbc.co.uk/1/hi/health/6483521.stm
post #28 of 29
FYI: NY Times Science section reported on one of the largest studies conducted on back pain that "heat therapy significantly reduced pain after five days compared with oral placebos and other remedies. There was less evidence for the reverse technique, cold therapy, though many doctors swear by it."

It went on to say that combining heat with light exercise had the best results with 70% to pre-injury function. It also noted that bed rest was only good for two days after which it actually did harm.
post #29 of 29
Ironic,you should mention this today, This morning I found myself bed-ridden due to back pain, not where I broke my back but at the location where I have a herniated disc. I elevated my legs and lay on top of a heat pad, after a few hours I felt much much better. Once I fully heal from my vertebrae fracture I am hoping that PT and working out at the gym will yield as good results for my back issues at they have in the past.
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